Health insurance serves as a crucial safeguard, shielding you from the financial burden associated with unexpected medical events. The best health insurance company in India offers comprehensive coverage, including pre-and post-hospitalisation, daycare treatments, surgeries, prescription medications, and more. Regarding parents, insurers now offer a variety of plans that can provide coverage to them, including the best health insurance plans for family and the best health insurance for senior citizens, giving you the freedom to choose.
However, navigating health insurance can be a daunting task, especially when it comes to understanding how to file a claim under a parent’s health insurance plan. If you’re confused about how to do so, then you’re on the right page.
Understanding Health Insurance Claims
When you raise a financial request to your insurance provider against any loss, treatment, injury, or any other medical condition that is listed in the insurance policy, it is known as a claim. After receiving the claim request, the best health insurance company in India reviews the claim to verify coverage and determine the amount payable. Once approved, the insurer either directly pays the healthcare provider or reimburses you.
When selecting the best health insurance plans for family ensure that the insurer has an efficient claim process. It is crucial for timely financial support and ensures you receive the benefits you are entitled to. But the question arises: how will you know whether the insurer has an efficient claims process or not?
The answer to your question is by looking into the insurer’s Claim Settlement Ratio (CSR), which represents the ratio of successful claims made by an insurer during a financial year. The best health insurance company in India has a higher CSR and is regarded as more reputed and reliable.
Types of Insurance Claims
Claims are an important indicator of an insurance company’s credibility and risk management capabilities. The two types of claims available under insurance policies are listed below.
Cashless Claims
If your parents fall ill and receive medical treatments at a network hospital, the insurer will cover their medical expenses without you having to worry. This procedure is known as cashless claims.
There are two situations under cashless claims:
- Planned Hospitalisation: In the case of planned hospitalisation, you have already scheduled the appointment or hospital admission in advance.
- Unplanned Hospitalisation: Unplanned hospitalisation involves unexpected medical emergencies.
Reimbursement Claims
If your parents receive medical treatment at a non-network hospital and you pay the bill yourself, then in such a case you can request reimbursement from your insurer. However, make sure to gather all necessary documents, such as invoices and receipts, to avoid claim rejection.
Benefits of Filing the Insurance Claims
Filing insurance claims on time prevents claim rejection and provides various benefits, which are listed below.
- Financial Protection: Claims provide financial protection by covering expensive medical and medication costs. Claims reduce out-of-pocket expenses, alleviating stress, and enable your parents to focus on their recovery rather than worrying about expenses.
- Access to Quality Care: Insurers offer preventive care, specialist visits, and emergency services, which are crucial for maintaining health. Filing claims ensures that you have access to a wide range of healthcare services and providers at affordable prices.
- Legal Process: Health insurance claims are regulated by laws and guidelines that protect consumers and ensure fair treatment.
- Record Keeping: When making claims, you submit a variety of documents that create a record of medical treatments and expenses, which can be used for future references or tax purposes.
Which Documents are Required for Filing Claims?
When filing claims under the best health insurance for parents or the best health insurance plans for family, you will need to provide the following documents.
- Identity proof
- Policy document
- Medical reports of your illness
- Hospitalisation papers, along with dates
- Medicine bills
- Ambulance bills
- Discharge papers
- Any other costs related to your treatment
What Is the Procedure for Filing Insurance Claims?
There are two different categories of insurance claims, and both have different claim filing procedures. Let’s take a look at them.
Cashless Insurance Claim Process
- Select Network Hospitals: Choosing network hospitals for medical treatments ensures a seamless experience. This enables you to settle claims directly with your insurer, simplifying the process.
- Pre-authorisation Request: You must submit the pre-authorisation form and all required documents. This ensures the insurance company is aware of your upcoming medical treatment.
- Incoming Approval: After submitting the documents, await your insurer’s approval. The insurance company will first review and then verify your documents before approving them.
Reimbursements Insurance Claim Process
- Settle Initial Expenses: When your parents receive medical treatment at a non-network hospital, and you are solely responsible for their expenses, you must keep all necessary documents to settle the claims with your insurer.
- Submit the Reimbursement Claim Form: After bearing all the expenses, you must submit the reimbursement form to your insurer along with all of the documents that provide proof of your medical expenses.
- Wait for Approval: After receiving all of your documents, the insurer will ensure that they comply with the policy’s terms and conditions.
Wrapping Up
Filing a claim under your parent’s health insurance may appear complex, but understanding the process will help you navigate it successfully. You can ensure that your parents receive the medical care they require while minimizing financial stress by knowing the different types of claims, their benefits, and the step-by-step procedure.
If you’re looking for an insurance provider that has a simplified and efficient claims process, look no further than Niva Bupa. They are known for their customer-centric approach and 30-minute cashless claim processing. Niva Bupa is trusted by over one crore happy customers and counting.
So, don’t wait; contact them right away.
